Dallas County Health and Human Services Heat-Related Illness Surveillance Program

State: TX Type: Model Practice Year: 2008

DCHHS began this system for sentinel detection and to reduce morbidity and mortality during extended periods of extreme heat conditions. Goals for this mission are to: 1) Expand surveillance from passive receipt of a report from an infection-control practitioner (ICP) to syndromic surveillance and acquire baselines for heat-related illness (HRI) and mortality in Dallas County; and 2) Communicate this information to key stakeholders in order to lessen excess morbidity from heat. Measurable objectives have driven the positive changes in this program. These objectives include (1) expanding the sources of the data to include syndromic systems by Year 3 (2006) and analyzing the data and demographics; and (2) working with the DCHHS Public Information Officer (PIO) to communicate educational information to key stakeholders pertaining to the analysis of the heat-related data from area providers, school nurses, public health personnel, and emergency managers to reduce heat morbidity.
The public health issue is fourfold for this practice. First, DCHHS is addressing preparedness issues with the effect of extreme heat on the elderly, children, those who work outside, and others. Second, DCHHS has a weatherization program that mitigates the effects of extreme heat and cold on the poor with weatherization efforts on their homes. Third, the program provides timely education to the citizens of Dallas County through the media on how to take care of themselves and others. Fourth, DCHHS can provide additional interventions through the development of interventions with school nurses and through the linking of programs currently in existence at DCHHS (e.g., the Weatherization Program and the Flu Program). DCHHS has the opportunity to work in a community that is a major U.S. media market. As a result, the response from the media and public is quite effective at communicating relevancy. One of the mainstays of senior staff is to meet with the press and key business and political leaders in the community. This ongoing process keeps DCHHS very aware of the community's needs. This practice, through the acquisition of baselines for HRI and mortality over a multi-year period and the ability to cause this particular health problem to have a situational awareness status, places DCHHS in a unique situation given the huge population in the area and likelihood of extreme temperatures. DCHHS can go beyond the traditional public health educational measures and add more specificity for interventions. Interventions can be refined to aid school nurses or for other situations. Moreover, the information from the HRI Program can help the director pinpoint areas for further weatherization or for referral to social service networks. Emergency managers and area leaders are aware on a situational awareness basis of when heat becomes an emergency public health event and how it develops. Another tool to add to the HRI Program is modeling of the data to better target educational efforts given the nature of the types of persons affected by extreme heat.
Agency Community RolesDCHHS met with ICPs as course of addressing public health program. The relationship with the hospitals had been established, and regular meetings were set to discuss issues over the year. Dallas ICPs continue to participate in the program and meet quarterly with DCHHS staff for this and other epidemiological or preparedness topics. Hospital staff receives from a DCHHS epidemiologist an analysis of whom is being affected, basic demographics, and anticipated temperatures for the immediate future. The role of DCHHS is to acquire the data, analyze data, and report data back to the providers. If anyone receiving the reports requests changes to the reports, then those requests are reviewed and implemented depending on group input. Both parties, providers and DCHHS, collaborate on ongoing issues and not just this one program. Costs and ExpendituresExisting epidemiology staff of DCHHS was used to create and implement this surveillance program. GIS support and analysis was provided by the epidemiology surveillance coordinator. Ongoing funding of enhanced computer equipment and specialized analytical software has been sought through small grants. Otherwise, half of one full-time employee (FTE) with high-level skills has been required for this project. ImplementationThis program builds on earlier surveillance control initiatives with ICPs. Actionable steps for the program: I. Goals 1, Objective 1 A. Programmatic updates. Timeframe: annually 2004-present. 1. Send ICPs letters requesting use of heat reporting form or submission in chief complaint field of syndromic data the words: heat exhaustion, heat cramps, or heat stroke. 2. Work with PIO on release of information to media. 3. Collect data 4. Conduct analysis. 5. Calculate statistics. 5a. Send weekly newsletter to ICPs and physicians; add others to list, such as school nurses, school directors of nursing. 6. Continue to use the new data to enhance reporting and analyses throughout year. 7. Director of DCHHS works with electricity provider to ensure availability of cooling center facility. II. Goals 2, Objective 2 A. Year 1 - Inform ICPs of need to monitor HRI at hospitals. Timeframe: January-April 2004. 1. Discuss HRI at heat meeting held with weatherization staff, interested politicians and key area stakeholders involved in providing heat/electricity to Dallas area, and advocates for elderly. 2. Check on presentations of heat at emergency departments in area hospitals 3. Create letter that talks about the dangers of extreme heat in Dallas area. 4. Show reporting form in informational packet to ICPs. 5. Talk about need to protect public health. 6. Health Authority informs ICPs of history of problem. 7. PIO works with media to get messages out on HRI B. Years 1 & 2: Initial data collection and reporting. Timeframe: April 2004–April 2006. 1. Meet with ICPs throughout year--assess need for information.2. Keep director and senior staff informed throughout year of HRI morbidity and mortality. 3. Data type: faxed sheets from ICPs for reports. 4. Acquire initial baselines for Years 1 & 25. Continue developing rapport with ICPs for program. 6. PIO works with media to get messages out on HRI C. Years 3 to present - Enhance analyses and increase interventions. Timeframe: May 2007–present. 1. Revise weekly reports. 2. Collect data. 3. Conduct analysis. 4. Calculate statistics. 5. Send reports. DCHHS use of syndromic surveillance has made a huge difference in surveillance activities and has brought HRI into situational awareness status, at least, with the availability of diagnostic designations.
The program experienced substantial increases since its inception in 2004. Syndromic surveillance caused number of cases detected in Dallas County to increase from 50 in 2005 to 160 cases in 2007. The weekly updates have generated considerable interest, causing the initial membership of 20 area providers to vastly expand. School nurses, school nurse directors, ICPs, physicians, public health officials, and emergency management personnel have asked to be on this list. Since the initial inception of this program, there has been a 400% increase in those persons requested to be added to the distribution list. The availability of these data has allowed DCHHS and its community partners to better tailor the type of interventions needed.
The program uses part of one FTE epidemiologist and depends on the DCHHS Emergency Preparedness Division’s budget. This program is starting its fifth year and intends to continue developing ways to enhance benefits to the community. Great interest exists among ICPs, school nurses, and emergency management professionals in the Dallas area. The system relies on the commitment of the people who express the most interest. Moreover, the DCHHS Director and Health Authority have been instrumental in the program's development. With such a low reliance on incoming funds and staff time, the program would seem readily sustainable in the future. Not many resources need to be leveraged to acquire and develop the data.